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Utilization Review RN - Regional Office - Silver Spring, MD - Utilization Review

Company: Kaiser Permanente
Location: Silver Spring
Posted on: March 17, 2023

Job Description:

Utilization Review RN - Regional Office - Silver Spring, MDThe Patient Care Coordinator is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.Essential Responsibilities:

  • Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.
  • Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.
  • Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.
  • Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.
  • Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
  • Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
  • Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.
  • Performs other related duties as directed.
    ELIGIBLE FOR $5,000 SIGN ON BONUS! -Will support DCSM/NOVA Core and Non-Core hospitals.Every other Weekend Commitment. - -Basic Qualifications: -Experience
  • Minimum one (1) year of experience as an RN in an acute care setting. -Education
  • N/A -License, Certification, Registration
  • This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
  • Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire - - - - - OR
  • Compact License: Registered Nurse within 6 months of hire
  • Registered Nurse License (District of Columbia) within 6 months of hire
  • Basic Life Support -Additional Requirements:
  • Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.
  • Ability to effectively communicate.
  • Ability to conform to established policies and procedures.
  • Ability to analytically problem solve and make decisions.
  • Ability to tolerate and cope with ambiguity
  • Ability to work as a team member.
  • Proficiency in the use of applicable computer software.
  • Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
  • Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information. -Preferred Qualifications:
  • Recent acute care, case management, or home health experience preferred.
  • B.S.N. preferred.#midapcc

Keywords: Kaiser Permanente, Silver Spring , Utilization Review RN - Regional Office - Silver Spring, MD - Utilization Review, Administration, Clerical , Silver Spring, Maryland

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